Abstract
An enlarged left atrial volume index (LAVI) at rest mirrors increased LA pressure and/or impairment of LA function. A cardiovascular stress may acutely modify left atrial volume (LAV) within minutes. Aim of this study was to assess the feasibility and functional correlates of LAV-stress echocardiography (SE) Out of 514 subjects referred to 10 quality-controlled labs, LAV-SE was completed in 490 (359 male, age 67 ± 12 years) with suspected or known chronic coronary syndromes (n = 462) or asymptomatic controls (n = 28). The utilized stress was exercise in 177, vasodilator in 167, dobutamine in 146. LAV was measured with the biplane disk summation method. SE was performed with the ABCDE protocol. The intra-observer and inter-observer LAV variability were 5% and 8%, respectively. ∆-LAVI changes (stress-rest) were negatively correlated with resting LAVI (r = − 0.271, p < 0.001) and heart rate reserve (r = -.239, p < 0.001). LAV-dilators were defined as those with stress-rest increase ≥ 6.8 ml/m2, a cutoff derived from a calculated reference change value above the biological, analytical and observer variability of LAVI. LAV dilation occurred in 56 patients (11%), more frequently with exercise (16%) and dipyridamole (13%) compared to dobutamine (4%, p < 0.01). At multivariable logistic regression analysis, B-lines ≥ 2 (OR: 2.586, 95% CI = 1.1293–5.169, p = 0.007) and abnormal contractile reserve (OR: 2.207, 95% CI = 1.111–4.386, p = 0.024) were associated with LAV dilation. In conclusion, LAV-SE is feasible with high success rate and low variability in patients with chronic coronary syndromes. LAV dilation is more likely with reduced left ventricular contractile reserve and pulmonary congestion.
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DM is the subproject leader; QC is the principal investigator of SE2020; VL is responsible for data analysis. CC is responsible for data quality control and reader' certification. MDN and MP helped to develop the web-based training. EP is the study chairman, designed the protocol, organized the content of web-based training, contributed to data analysis and drafted the manuscript. All authors contributed to the study design, undertook the quality control up to certification, are active recruiting members of SE 2020 consortium, critically revised the manuscript for an intellectually important contribution and approved the submitted version.
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Morrone, D., Arbucci, R., Wierzbowska-Drabik, K. et al. Feasibility and functional correlates of left atrial volume changes during stress echocardiography in chronic coronary syndromes. Int J Cardiovasc Imaging 37, 953–964 (2021). https://doi.org/10.1007/s10554-020-02071-5
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DOI: https://doi.org/10.1007/s10554-020-02071-5